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Acute postoperative seizures and long-term outcome following pediatric epilepsy surgery

Hansel M Greiner1, Paul S Horn1, Ravindra Arya1

  • 1Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Seizure
|April 1, 2014
PubMed

Insights

Acute post-operative seizures (APOS) in pediatric epilepsy surgery indicate a poor long-term prognosis. Expanding the definition of APOS to 30 days is supported by this study.

Area of Science:

  • Pediatric Neurology
  • Epilepsy Surgery
  • Clinical Outcomes

Background:

  • Acute post-operative seizures (APOS) after epilepsy surgery were previously considered benign.
  • Emerging evidence suggests APOS may be linked to poorer long-term outcomes.
  • Most prior research focused on adult temporal lobe epilepsy.

Purpose of the Study:

  • To determine the prevalence of APOS in pediatric epilepsy surgery.
  • To assess the prognostic significance of APOS in children.
  • To identify risk factors associated with APOS in pediatric epilepsy surgery.

Main Methods:

  • Retrospective chart review of pediatric patients (0-21 years) undergoing epilepsy surgery (2009-2012).
  • APOS defined as seizures within 30 days of resection.
  • Minimum 12-month postoperative follow-up for outcome assessment.

Main Results:

  • APOS occurred in 44% of patients (50/112).
  • APOS significantly predicted poor seizure outcome (26% good outcome vs. 76% without APOS).
  • Risk factors included lack of ictal EEG lateralization; hemispherectomy APOS did not worsen prognosis.

Conclusions:

  • APOS are associated with poor outcomes in pediatric temporal and extratemporal epilepsy surgery.
  • The study supports extending the definition of APOS to 30 days post-surgery.
  • Findings highlight the importance of monitoring early post-operative seizures in pediatric epilepsy surgery.
Abstract

Keywords:
Acute postoperative seizuresEpilepsy surgeryOutcomePediatric epilepsy surgery

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